Journal Article

Impact of physical exercises on immune function, bone mineral density, and quality of life in people living with HIV/AIDS: a systematic review with meta-analysis

Nnamani, Amaka Obiageli, Irem, Franklin Onyedinma, Ezuma, Amarachi Destiny, Ezeofor, Salome Nwaelom, Fortwengel, Gerhard, Ezenwankwo, Fortune Elochukwu, Dim, Ngozi Regina, Okere, Philip Chinedu, Iloanusi, Nneka Ifeyinwa, Ibeneme, Sam Chidi

2019

Overview

Background Compromised immune function, associated with human immune deficiency virus(HIV) infection, is improved by antiretroviral therapy(ART) which also decreases bone mineral density(BMD), and possibly the quality of life(QoL). However, physical(aerobic/resistance) exercises, were reported to induce reverse effects in uninfected individuals and were appraised in the literature for evidence of similar benefits in people living with HIV/AIDS(PLWHA). The main study objective was to evaluate the impact of physical (aerobic and resistance) exercises on CD 4+ count, BMD and QoL in PLWHA. Methods A systematic review was conducted using the Cochrane Collaboration protocol. Searching databases, up to June 2017, only randomized control trials investigating the effects of either aerobic, resistance or a combination of both exercise types with a control/other intervention(s) for a period of at least 4 weeks among adults living with HIV, were included. Two independent reviewers determined the eligibility of the studies. Data were extracted and risk of bias(ROB) was assessed with the Cochrane Collaboration ROB tool. Meta-analyses were conducted using random effect models using the Review Manager(RevMan) computer software. Results Nineteen studies met inclusion criteria( n  = 491 participants at study completion) comprising male and female with age range 22–66 years. Two meta-analyses across 13 sub-group comparisons were performed. However, there were no RCTs on the impact of physical exercises on BMD in PLWHA. The result showed no significant change in CD 4+ count unlike a significant effect of 5.04 point(95%CI:-8.49,-3.74, p  = 0.00001) for role activity limitation due to physical health(QoL sub-domain). Overall, the GRADE evidence for this review was of moderate quality. Conclusions There was evidence that engaging in moderate intensity aerobic exercises (55–85% Maximum heart rate-MHR), for 30–60 min, two to five times/week for 6–24 weeks significantly improves role activity limitation due to physical health problems, otherwise physical(aerobic or/and resistance) exercises have no significant effects on CD4 + count and other domains of QoL. Also, there is lack of evidence on the impact of exercises on BMD in PLWHA due to the paucity of RCTs. The moderate grade evidence for this review suggests that further research may likely have an important impact on our confidence in the estimate of effects and may change the estimate.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acquired immune deficiency syndrome / Adult / Aerobic exercise / Aerobic exercises / Aged / AIDS / Antiretroviral agents / Antiretroviral therapy / Bone density / Bone Density - physiology / Bone mineral density / CD4 antigen / CD4+ cell count / Collaboration / Diagnosis / Domains / Exercise / Exercise - physiology / Exercise - psychology / Exercise Therapy / Female / Health aspects / Health problems / Heart rate / Highly active antiretroviral therapy / HIV / HIV and co-infections / HIV infections / HIV Infections - immunology / HIV Infections - physiopathology / HIV Infections - psychology / HIV Infections - therapy / HIV patients / Human immunodeficiency virus / Humans / Immune response / Infectious Diseases / Internal Medicine / Male / Medical Microbiology / Medicine / Medicine & Public Health / Meta-analysis / Middle Aged / Parasitology / QoL / Quality of life / Quality of Life - psychology / Research Article / Resistance exercise / Retirement benefits / Systematic review / Tropical Medicine / Viruses / Young Adult